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Complaint Investigation Form Report#:5104 <br /> COMPLAINT ID: 000035716 Site Location: 3919 FRENCH CAMP RD Account 10, : <br /> Received by: EE0009058 LOWE Received Date: 11/26/2012 <br /> Print Date: 11/27/2012 10:37:47Afv[ <br /> Assigned Ta: EE0007380 SH1H Assigned Date: 11/27/2012 <br /> Proaram/Element 01600-FOOD PROGRAM <br /> Complainant: :JULIE MANGNEY Nome Phone <br /> 408-888-2988 <br /> Address <br /> Work Phone <br /> -Mail Address <br /> Nature of Complaint: <br /> (C)AND A GROUP OF FRIENDS STAYED AT THIS RV PARK FROM 11/14/2012 TO 11/1612012.(C)'S WERE ALLOWED TO USE ON SITE <br /> KITCHEN AT CLUB HOUSE.(C)STATED THE KITCHEN IS VERY DIRTY AND HAS PEST ISSUES. (C)AND MANY FRIENDS GOT SICK AND <br /> ENT TO SEE THE DOCTOR AFTERWARDS, <br /> Complaint Mode: p Complaint Mode Codes A-Agency Referral B-Bd of Supervisors I City Council C-Counter F-Fax <br /> E-Code Enforcement M-Mail I Correspondence O-Other EH Unit P-Phone <br /> I-lntemet I Email S-Sheriff's Office <br /> PROPERTY INFORMATION PROPERTY OWNER INFORMATION <br /> Property Name: Responsible Party or Property Owner <br /> Site Location 3919 FRENCH CAMP RP/DBA <br /> FRENCH CAMP,CA RPAddress <br /> Cross Street <br /> Billing Address <br /> Home Phone <br /> Phone Work Phone <br /> District 003-BESTOLARIDES Location Code 99-LTNINCORPORATED AREA <br /> APN <br /> Date Abated Inspector ID#: <br /> Send Referral to Referral Letter Sent by <br /> Referral Address Y Date: <br /> Complaint Status Code: v <br /> Circle appropriate Status Code <br /> 15-ACTIVE HOUSING CASE-NEW COMPLAINT see ACTIVE CASE# <br /> 01-FIELD ABATED 28-FOODBORNE ILLNESS-No Major Violations Identified <br /> 02-OFFICE ABATED 29-FOODBORNE ILLNESS-Major Violations Identified <br /> 03-NAI SENT 50-LEAD Assessment Performed-No Abatement Required <br /> 04-NOTICE TO ABATE ISSUED 52-LEAD Abatement Reqired-See Program Record File <br /> 05-DA-ENFORCEMENT ACTION INITIATED 97-Disaster Planning and Response <br /> 06 D FACILITY-see Linked PROGRAM FACILITY FILE 99-UNSPECIFIED-Old Complaint-No Original Found <br /> 7- FERRED TO OTHER AGENCY CL-Case Closed <br /> 08-UNABLE TO VERIFY <br /> 10-POSTED SUBSTANDARD/UNSECURED-See Housing File <br /> 11-Multiple Complaints-SEE ACTIVE CASE# <br /> 12-DA Referred Complaint-See Violation Tracking Form <br /> 5104.rpt <br />